A case report described a 30-year-old lady who underwent an anterior cervical discectomy for a C5–C6 disc prolapse causing radiculopathy. She was given a Philadelphia collar, postoperatively and discharged 3 days after the surgery. 2 weeks later she had an intensely pruritic, erythematous, sharply demarcated rash involving the neck, the lower part of the face, and upper part of the chest, which looked like dermatitis of niacin (Vitamin B3) deficiency–Casal′s collar. No other features of pellagra were noted. The localized nature and time frame of rash development prompted the diagnosis of allergic contact dermatitis. Treatment included removal of the collar and application of topical steroid ointments which caused complete regression of lesion in 3 weeks.

Allergic contact dermatitis, a type 4 delayed hypersensitivity response mediated by T lymphocytes, develops when a patient′s skin contacts an allergen. It is the commonest inflammatory disease of the skin and has women predilection. Cervical collar applications may have complications such as erythema, skin breakdown, and pressure ulcers which have been reported to occur in 7 to 23% of adults. Some of these complications can be prevented by adding extra padding at pressure points.

Source- J Neurosci Rural Pract. 2022;13(1):159-160. Published 2022 Jan 5. doi:10.1055/s-0041-1740454